Friday, February 25, 2011

Social Commentary Courtesy of

I am obviously addicted to Apparently this shopping list was discovered at a Walmart in Virginia. I'm not sure if it reflects more poorly on the American diet or on our educational systems. I do, however, have a pretty good suspicion that the authors of this list may need some cardiac care in the near future.

Wednesday, February 23, 2011

The Scary Dad

Whenever I work in Preop Holding, something weird or confusing seems to happen. Last week I had a patient coming from our ER.  The patient was a 4 year old boy who had stuck a tiny Lego bit up his nose. The ER doctor and the ENT on call had been unable to retrieve the errant Lego in the ER, so surgery was scheduled for the little guy. Fishing out foreign bodies from various bodily orifices is a pretty common activity in the surgical suite, so as is the routine I called the child's ER nurse for a quick report. The nurse was obviously an intelligent woman, giving me an excellent detailed report. Now I admit I am biased towards ER nurses. They do it all, do it fast, and often do not get the repect they deserve. I started out in the ER and still see pretty much everything through that perspective. But this nurse went off on a lengthy tangent that freaked me out a little bit. She started talking for a while about how the father of the child was a militant "foreign" Muslim who hated white women and was disrespectful to the female nurses. "You know how they are." she said about male followers of Islam.
  It was an unusual way to end the report, so I figured this guy must be a real terror. I immediately pictured a bearded man screaming in a foreign language at the staff. Imagine my surprise when the man in question turned out to be a pretty ordinary looking guy who spoke English well. The little boy was an absolute cutie pie. As I was getting him and his mountain of paperwork ready, I kept waiting for the dreaded misogynistic outburst from the Dad. I waited and waited. I am half Latina, with my Mom's pale Irish skin and my Dad's crazy frizzy/curly hair. So, maybe I did not count as an actual white woman. However, my coworker is a 100% lily white, sweet as pie platinum blonde Southern girl, so maybe he would direct his ire at her. Nope. He was complimentary and gracious to her as well. As I escorted him to the wating room, he thanked me and told me I had a nice personality. Religion was not mentioned by anyone at anytime. I really couldn't figure it out. I simply treated him as I would want to be treated if I brought in my child with a Lego up his little nose. Had the guy undergone a total personality change between the ER and Preop Holding? Had the otherwise smart ER nurse misinterpreted his behavior? I didn't know what was going on. It was weird.

Wednesday, February 9, 2011

What Would You Do for a Beautiful Butt?

We have had several of these cases in South Florida, where someone illegally and dangerously practiced "cosmetic surgery". However, often they have preyed on our large Spanish speaking population. These women purposefully flew here from England to get this done. Very sad.   Interesting how the others just went on to their party.

As for me, my butt is big enough. In fact, I would happily donate some adipose tissue to anyone that needs some !


From the Philadelphia Inquierer

U.K. woman dies after illegal buttocks-enhancement injections in Phila.

Two women from the United Kingdom flew into Philadelphia on Saturday looking to improve their physiques with buttocks-enhancement injections.
Only one survived.
The other died at a Delaware County hospital Monday, and Philadelphia homicide detectives are now seeking two women who provided the syringes and unknown drugs in a hotel room near the airport.
Their clients were part of a group of four women, all in their 20s, who arrived Saturday. The two who did not receive injections were on their way to a party in New York City, said Detective Lt. John Walker.
Late Tuesday, police confirmed that the dead woman was named Claudia Adusei, 20. British news reports said she was from London. Police said that the other woman told them the women thought they were being injected with silicone. The autopsy will show whether the substance was in fact silicone, police said.
Buttocks-enhancement injections, often involving silicone gel or liquid, are illegal but widely available. Dozens of women have reported injuries, according to federal health agencies, including infections, kidney impairment, and, in rare instances, death.
Walker said the victim checked into the Hampton Inn on Bartram Avenue and sometime over the weekend received the injections. She was taken to Mercy Fitzgerald Hospital at 1:30 a.m. Monday after complaining of chest pains and experiencing shortness of breath.
She died later that day. Fredric Hellman, Delaware County medical examiner, said a preliminary cause of death will not be released until the victim's relatives are notified. The second woman, who received injections to her buttocks and hips, has not been hospitalized, police said.
Legitimate buttocks enhancements using silicone implants are relatively rare - about 5,000 were done throughout the nation last year. There is a large illegal underground market for the sale and injection of silicone even though it has been decades since any product has been approved by regulators for reshaping a body part.
"Silicone injections used to be done years ago to make breasts bigger . . . but that has not been done, legitimately, for 40 or 50 years," said R. Barrett Noone, a Bryn Mawr plastic surgeon who serves as executive director of the American Board of Plastic Surgery.
The FDA, on its website, says the agency has "prohibited the injection of liquid silicone or silicone gel to fill wrinkles or augment tissues anywhere in the body." It has been blamed for autoimmune disease and physical disfigurements.
Collagen injections, using a substance made from protein, have been approved by the FDA to fill small imperfections, typically in facial areas. Some clinics in the United Kingdom offer buttocks and breast injections with a different processed protein, but the cost is about $4,500.
Last month, federal agents in New York City charged a woman with illegal distribution of silicone imported from the Dominican Republic. She was accused of administering illegal injections of liquid silicone for cosmetic purposes as part of a business run out of her Bronx home, allegedly charging up to $1,000 for a round of shots.
Last year, Essex County, N.J., prosecutors brought criminal charges against a professional model who allegedly offered women a series of injections to enlarge their buttocks. Six of her customers later sought medical treatment at local hospitals, said Katherine Carter, a spokeswoman for the county prosecutor. "They all had serious bacterial infections that required them to get surgery," Carter said.
They paid $600 to $1,000, allegedly to Anivia Cruz-Dilworth, 28, of New Brunswick, who was indicted for delivering illegal injections of a substance called "Hydrogel."
More famously, a former Miss Argentina, Solange Magnano, died after a buttocks-enhancement procedure at a medical clinic in Buenos Aires. She spent three days in critical condition after suffering from a pulmonary embolism. The Associated Press reported that sources described her procedure as a "gluteoplasty," which usually involves implants. But a friend said Magnano also received injections.

Saturday, February 5, 2011

Bariatric Sensitivity Training

   Our hospital, in an effort to become a Bariatric Center of Excellence or some such nonsense, is requiring all staff, including physicians, to attend a bariatric sensitvity course. Now I will be the first to say that I could lose a few pounds. I have a "healthy" BMI, but am at the top end of normal, so three or four more pounds and I would be officially in overweight territory. So I am not some skinny girl hating on anyone heavier than me. I could definitely use more exercise and less sugar, no doubt about it. And of course everyone from Michelle Obama to Elmo is talking about America's obesity issue on television. However, I have to say that this class was by far not the most productive hour of my week.
   We spent the first half of the course covering points that hopefully those of us who are not complete a#%holes already knew. Obviously we should provide a larger bed for a larger patient, so they don't fall out.  Another example: when weighing an obese patient, we should not rudely holler out their weight so loudly that the entire unit can hear it. We also should not yell out "Hey Joe, we need to get the Big Boy wheelchair for this one", an actual example from the power point presentation.  We were also instructed to always provide an extra large gown for our bigger patients, which of course we would do anyway.
   Some of the other points, however, confused and disturbed me a little bit. We were instructed, in an effort to be sensitive, to not weigh a patient if they are uncomfortable about being weighed. Really? Many meds are weight based. An accurate weight is pretty helpful. A CHF patient often needs daily weights to determine if they are retaining fluids or not. This is a more complicated issue than it would seem.
   Another idea that seemed a little out of hand was to only discuss the patient's weight if the patient brought the subject up and wanted to talk about it. Apparently there have been a rash of patient complaints lately in which the patient was offended that a doctor or nurse had the temerity to advise that some weight loss might be a good idea if the patient wanted to live a few more years free of strokes, heart attacks and other not so pleasant things. This just flies in the face of common sense. Isn't prevention of health problems what we are going for (ideally) ? Are we not going to tell the chronic alcoholic with the cirrhotic liver that they should quit drinking? Do we not tell the diabetic who neglects their insulin that if they don't start taking care of themselves that little foot wound could result in an amputated leg? There are patients in our ICU right now who would not be there if not for their morbid obesity. That is a fact.
   We have extra large OR tables. We supposedly have "lift teams".  We have a special private preop area for bariatric surgery patients. We generally speaking are not jerks. We don't typically go around  making fun of anyone's weight. Sure, I know the patient probably aleady realizes they need to lose weight. Yes, I know many people would simply choose to ignore our advice. But damn...if we can't even talk about it in a sensitive manner, even raise the subject of possibly trying to lose some weight, how does that help anyone?